Case management (mental health)

Case management is the coordination of community-based services by a professional or team to provide quality mental health care customized accordingly to individual patients' setbacks or persistent challenges and aid them to their recovery.[1][2] Case management seeks to reduce hospitalizations and support individuals' recovery through an approach that considers each person's overall biopsychosocial needs without making disadvantageous economic costs. As a result, care coordination includes traditional mental health services but may also encompass primary healthcare, housing, transportation, employment, social relationships, and community participation. It is the link between the client and care delivery system.[2]

Development

The case management model developed in the US was a response to the closure of large psychiatric hospitals (known as deinstitutionalisation) and initially for provision of services which enhances the quality of life without the need for direct patient care or contact.[3] Clinical or therapeutic case management then developed as the need for the mental health professional to establish a therapeutic relationship and be actively involved in clinical care, often in this only the personal and interpersonal resources are utilized. The process involved can be cyclical because of its client-centered nature.[4] According to the American Association on Mental Retardation (1994) "Case Management (service coordination) is an ongoing process that consists of the assessment of wants and needs, planning, locating and securing supports and services, monitoring and follow-along. The individual or family is the defining force of this service coordination process."[5]

A more active form of case management is present in assertive community treatment (or intensive case management, if the services go beyond the scope of time), this provides an approach in psychiatric case management with coordinated services that promote increased wellness for the management's (homes or agencies) population. This form of management is often a part of managed care systems and falls in legal trouble for coerced care, others include health maintenance organizations, point-of-service plans, and preferred provider arrangements. These managed care services utilise case management as a system to allocate lower-cost service options instead of higher-cost ones, such as outpatient therapy as an alternative to hospitalisation, this limits clients access to services and boxes the overall care to its limits.[6]

Functions

Case management is about engaging the clients in a process, not processing clients, and the point of service is accountability. Hence, Rose and Moore in 1995 defined the following as case management functions:[1]

  1. Outreach or identification of clients
  2. Assessment of individual needs
  3. Service or Care planning
  4. Plan implementation
  5. Progress monitoring
  6. Regular review and Termination

In cases when re-assessment might identify more than one needs and they are required to be delivered, a new case management cycle is initiated. Cause of the new cycles initiated it is often critiqued that case management leads to dependence rather than independence.[7]

The case manager becomes an effective facilitator or enabler by use of self, understanding the social systems, the etiology of needs, and functioning of the clients. Moore in 1990s said that a case manager should possess the clinical skills of a psychotherapist and the advocacy skills of a community organizer.[8] A client record is maintained by the case manager for effective delivery of services per agency policy. Newer forms of record keeping involve using checklist and scan sheets for decentralized and statistical outcome management.[1] Others who have explained the functions and tasks of a case manager are Grube & Chernesky, 2001; Mather & Hull, 2002; and Vourlekis & Green, 1962.

Models

Several models of case management emerged to coordinate care for individuals with different assessment and re-assessments involved. These models differ in their approach to care, frequency of contact, the number of professionals and referrals involved. In addition, outcome evaluation is typically used to assess the effectiveness of treatment interventions. Researchers have developed fidelity measures to assess the implementation of a particular case management model.[9]

A 2010 review shows the following similarities and differences in different models of case management with regards to the way they operate:[2]

Model Developed Focus[2] Case manager(s)[2] Client(s)[2] Fidelity measure(s)
Broker case management ? Connect client to services Individual/Individual with optional assistant/Team Individual/Group ?
Clinical Case Management ? Involve case manager in treatment Individual Individual ?
Strengths based case management /
Personal Empowerment Model		 1980s[9] Client abilities and interests Individual Individual Strengths Model Fidelity Scale[9]
Rehabilitation case management Boston University Psychiatric Rehabilitation Center Client goals, disability rehabilitation plan Individual Individual ?
Assertive Community Treatment 1970s by Marx, Test, and Stein Reduce hospitalizations Continuous care team,
10–12 multidisciplinary personnel with shared caseloads[9]		 Individual
  • Dartmouth ACT Scale
  • Tool for Measurement of ACT[9]
Intensive Case Management ? Reduce hospital and emergency service use through assertive outreach. Individual Individual ?

Effectiveness of managed care models

A systematic review investigated the effects of intensive case management for patients with severe mental illness:

Intensive case management versus standard care[10]
Summary
Based on evidence of variable quality, ICM is effective in helping many outcomes relevant to people with severe mental illness. Compared to standard care, ICM may reduce hospitalization and increase retention in care. It also globally improved people's functioning socially, but ICM's effect on mental state and quality of life remains unclear.

See also

References
  1. Onyett, Steve (1998) [1992]. Case management in mental health (reprint ed.). Cheltenham, UK: Stanley Thornes. p. 3. ISBN 978-0-7487-3845-8.
  2. Ivezić, Slađana Štrkalj; Mužinić, Lana; Filipac, Vanda (March 2010). "Case management: a pillar of community psychiatry" (PDF). Psychiatria Danubina. 22 (1): 28–33. PMID 20305587.
  3. Intagliata, James (1982). "Improving the quality of community care for the chronically mentally disabled: the role of case management". Schizophrenia Bulletin. 8 (4): 655–74. doi:10.1093/schbul/8.4.655. PMID 7178854.
  4. Holloway, F (March 1991). "Case management for the mentally ill: looking at the evidence". International Journal of Social Psychiatry. 37 (1): 2–13. doi:10.1177/002076409103700102. PMID 2045238. S2CID 32747769. (subscription required)
  5. Kanter, Joel (April 1989). "Clinical case management: definition, principles, components". Hospital and Community Psychiatry. 40 (4): 361–8. CiteSeerX 10.1.1.465.917. doi:10.1176/ps.40.4.361. PMID 2714749. (subscription required)
  6. Stein, Leonard I.; Test, Mary Ann (April 1980). "Alternative to mental hospital treatment: I. Conceptual model, treatment program, and clinical evaluation". Archives of General Psychiatry. 37 (4): 392–7. doi:10.1001/archpsyc.1980.01780170034003. PMID 7362425. (subscription required)
  7. Everett, Barbara; Nelson, Anne (1992). "We're not cases and you're not managers: An account of a client-professional partnership developed in response to the "borderline" diagnosis". Psychosocial Rehabilitation Journal. 15 (4): 49–60. doi:10.1037/h0095746.
  8. Betsy Vourlekis; Roberta R. Greene (5 July 2017). Social Work Case Management. Taylor & Francis. p. 182. ISBN 978-1-351-48933-1.
  9. Teague, Gregory B.; Mueser, Kim T.; Rapp, Charles A. (August 2012). "Advances in fidelity measurement for mental health services research". Psychiatric Services. 63 (8): 765–71. doi:10.1176/appi.ps.201100430. PMC 3954528. PMID 22854723.
  10. Dieterich, Marina; Irving, Claire B.; Bergman, Hanna; Khokhar, Mariam A.; Park, Bert; Marshall, Max (6 January 2017). "Intensive case management for severe mental illness". The Cochrane Database of Systematic Reviews. 1: CD007906. doi:10.1002/14651858.CD007906.pub3. ISSN 1469-493X. PMC 6472672. PMID 28067944.

Further reading
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